Nancy Gerrard
June 8, 2014
 Alternative
depression
3
treatments for
new medications
 Drugs
of abuse



Young adult years have also been called the
AGE of INSTABILITY
EMERGING ADULTHOOD

Children and adolescents increasingly take
antidepressants (1/13 on psych meds)
Thin line between diagnosing depression and
teaching youth to view any emotional upset
as pathological

NY Times, Iarovici, April 2014










Patients I see at the University Health Center:
Anxiety
Depression
Bipolar disorder
First episode psychosis
Obsessive Compulsive Disorder
Eating disorders
ADHD
Transgender clients
Alternative therapies
Depressed mood most of day
 Diminished interest in pleasurable
activities
 Decrease or increase in appetite
 Insomnia or hypersomnia
 Psychomotor agitation or retardation
 Fatigue or loss of energy
 Feelings of worthlessness or excessive
guilt




Diminished ability to think or
concentrate
Recurrent thoughts of death, recurrent
suicidal thoughts or attempts
These symptoms occur nearly every day
and they cause clinically significant
distress or impairment in social,
occupational or other important areas of
functioning.
 Genetics
 Situational
(life events and
environmental stress)
 Personality or temperament
 Biological/medical factors
 Drug/alcohol induced
 Therapy
 Medications
 Combination
of therapy and
medication
 Hospitalization









Prozac
Paxil
Zoloft
Celexa
Lexapro
Cymbalta
Effexor
Pristiq
Wellbutrin
Sleep
Healthy diet
No alcohol or drugs
Limit caffeine use
Get outside for natural light at least 20
minutes per day
Exercise daily
Socialize with positive people
Hastens the effects of
antidepressant drugs
Rapid onset of antidepressant
action
Antidepressant effects mediated
through eyes
Useful as a nonpharmacological
intervention during pregnancy
Use a light box with full spectrum
light – 10, 000 lux
Time with patient’s circadian phase
of melatonin secretion (7.5-9 hrs
after evening melatonin secretion
Rare side effects such as: headache,
eyestrain, nausea, and agitation
Approved for treatment resistant
depression
 Electromagnetic coil placed against
scalp and delivers pulses
 Session is between 30-50 minutes
 Treatments are 5x week for 4-6 weeks
 Occasional headache after treatment
 Some insurance coverage

Deep brain stimulation (same as
what is used for Parkinsons)
Electroconvulsive therapy (ECT)
Sleep Deprivation (still being
studied)





L- methylfolate or Deplin
A form of folate that can cross blood brain
barrier
70% of depressed persons have a genetic
factor that limits their ability to convert folic
acid or folate in food to l-methylfolate.
L-methylfolate regulates neurotransmitter
production
Used as an adjunct to antidepressant
medications
 St
John’s wort – antidepressant
effects (mild to modest effects)
 SAMe – possible benefit for
depression
 Omega 3 – possible benefit for
depression
 Melatonin- possible benefit for
depression but can improve sleep
 Psychotherapy
 Visualization
 Journaling
 Meditation
 Acupuncture
Fetzima – antidepressant
Works on norepinephrine and
serotonin
In same family as cymbalta, pristiq,
effexor
Latuda – atypical antipsychotic
Using for mood stabilization, psychosis,
adjunct for depression
Same family as Abilify, Geodon,
Zyprexa, Seroquel
Brintellex – antidepressant
Works on serotonin but several
different receptors involved. Less
weight gain and less sexual side
effects reported
 Most
frequently used drug by
teens
 ½ of jr high students drink
monthly
 14% of teens intoxicated at least
1x in past yr.
 8% of teens who drink, drink 5+
drinks
 Underage
drinking attracts many
developing adolescents
 Peer
pressure
 Increased independence
 Easy access
 Increased stress







Lowers attention/car accidents
Decreases memory
Tend to mix with other drugs – DANGER
Intoxication associated with suicides and
suicide attempts
Males tend to complete less yrs of education
if abusing alcohol
Drinking increases risk of engage in unsafe
sexual practices, or victimization
Brain is still developing in adolescents
Family history of alcoholism
 Genetics
 Environment
 Family problems
 Peers abusing alcohol
 Psychiatric problems
 Personality (risk takers)

Dried flowers, leaves, stems, seeds
from hemp plant Cannabis Sativa
which contains THC
 Most common illicit drug used in US
 Hand rolled in cigarettes or used in
pipes or water pipes (bongs).
 Can also be mixed in food or brewed
as a tea






THC rapidly passes through lungs into blood
which carries chemical to brain and other
organs
Influences pleasure, memory, thinking,
concentration, sensory, and time perception
Can affect brain development in young
people – affects thinking and memory
Increases HR by 20-100% which can last 3
hrs.
Increased risk of heart attack



High doses of marijuana can cause a
temporary psychotic reaction (hallucinations
and paranoia)
Possible link between marijuana and later
development of psychosis
Long term marijuana users trying to quit have
irritability, sleeplessness, decreased appetite,
anxiety, drug craving


In 1980, the concentration of THC in
marijuana was 4%
In 2012, the concentration of THC in
marijuana was around 15%
Big problem on college campuses
 Stimulants cannot make you smarter!
 Persons like to go after the “rush” or
the “high” that stimulants can give
 Also allow to stay awake all night to
study
 Statistics are hard to find for the
amount of abuse

Labeled as not for human consumption
Camouflaged under names such as stain
remover, insect repellant
Active ingredients are a moving target
Grown in popularity due to representation as
legal and their limited detection by standard
tests
May present with s/s that resemble psychiatric
disorders such as schizophrenia, anxiety,
depression
Longterm consequences relatively unknown
First used in US in July 2010
Cheap ($20-50 per 50mg packet)
Users predominantly young and
male
Often coingested with marijuana,
alcohol, opiods
Contain ingredients similar to
ecstasy, methamphetamine,
cocaine
Contains cathinone in khat plant
Increase in serotonin, dopamine,
norepinephrine
Purple wave
 Zoom
 Cloud Nine
 Lunar Wave
 White Lightening
 Scarface
 Vanilla Sky
 Bloom

 Cause
a surge in dopamine
 Also surge in norepinephrine
Desired effects:
Euphoria
Alertness
Increased sociability
Increased empathy
Intensification of sensory experiences
Sexual arousal
Adverse effects
Tachycardia
Hypertension
Hyperthermia/sweating
Mydriasis
Seizures/spasms
Respiratory distress
Death
Behavioral side effects
Panic attacks
Agitation
Hallucinations/psychosis/paranoia
Aggression
Self mutilation
Insomnia
Depression
May be inhaled, injected, snorted,
swallowed , or inserted into rectum
or vagina
Effects occur with doses of 2-5mg
Typical dose is 5-20mg
Effects occur 10-20 minutes after
ingestion
Desired effects last 2-4 hrs
Addiction potential: strong urge to
re-dose occurs 20-30” after
ingestion
May be 10x more addictive than
methamphetamine in rat studies
What to look for:
May mimic a psychiatric disorder
Disorientation/agitation
Dilated pupils with nystagmus
Lockjaw and teethgrinding
Rapid, loud, incoherent speech
Emotional, verbal, physical abuse
Negative results on standard urine
toxicology but developing new testing
Treatment
Mainly supportive
Sedatives (benzodiazepines)
Monitor for respiratory depression
Antipsychotics
Physical restraints may be necessary
Lab work may show elevated liver
enzymes
Inderal for BP, tachycardia, tremors,
sweating







Pure form of MDMA or Ecstacy
Many more times potent than MDMA
Popular
Makes it feel as if “everything is right with the
world”, euphoria
Usually taken as tablet or capsule
Surge of serotonin – emotional closeness,
sexual arousal
Negative: confusion, depression, sleep
problems, anxiety
Synthetic cannabinoids
Designed to mimic THC
(tetrahydrocanninol)
Carry a higher risk of causing psychois
1st appeared in US in 2008
77% of users are male
Inhalation most common route of
administration
$10-20 per gram (usual dose is 0.3g)
What to watch for:
Agitation
Anxiety/Depression
Elevated Blood Pressure/Tachycardia
Hallucinations/Paranoia
Nausea
Seizures
Symptoms may last up to 6 hrs
Commerical testing is available –
formulations change so rapidly that
testing quickly becomes obsolete
IV benzodiazepines usually treat
Kidney failure reported in several cases
Possible 3x risk of psychosis
Depression and suicidal ideation may
continue
Dependence and withdrawal reported
Derived from salvia divinroum, a
member of the mint family
Works on kappa opiods
Smoke or ingest salvia leaves
Low addiction potential
May have antidepressant effects
Desired effects
Relaxation/better mood
Intense psychedelic effects
Hallucinations
Floating feeling, dream like experience
Increase of sensual and aesthetic
appreciation
Increased self confidence/insight
Spiritual experience
Adverse effects
Racing thoughts
Sleeplessness
Dizziness
Anxiety
Psychosis
Agitation
Sweating/chills
Nausea/vomitting
 Website:
 www.
Erowid.org






National Institute of Health, www.nih.gov/
April 2014
Saddock & Saddock, Synopsis of Psychiatry,
9th edition, 2003
DSM-5, Diagnostic and Statistical Manual of
Mental Disorders, American Psychiatric
Association, 2013
MedicineNet.com, March 2014
NEI Psychopharmacology Congress, 2013
Iarovici, NY Times, April 2014
A student with a history of illicit
substance abuse is considering trying
bath salts as a cheap alternative high
that won’t be detectable in standard
drug tests. Recent studies indicate:
 A. it is 10x more addictive
 B. 5x less addictive
 C. 10x less addictive

In 2009, what percentage of 16-17 yr
olds drove under the influence of
drugs/alcohol
 A. 1.2%
 B. 3.6%
 C. 6.3%
 D. 10.7%

 Which
of the following statements
about adderall (stimulant) is true?
 A. It can make you smarter
 B. It can help a person focus, even
if they don’t have ADHD
 C. It causes your body to need
less sleep
 D. None of the above
Alcohol and marijuana are the drugs
most abused by teens. What comes
next?
 A. Ecstacy
 B. Cocaine
 C. Bath Salts
 D. Prescription drugs and cough
medicine
 E. Tobacco

What are things dangerous about bath
salts?
 A. Cause paranoia, hallucinations,
violent behavior
 B. Made with cathinones
 C. May end up in emergency room
after taking them
 D. Contain unknown ingredients
 E. All of the above
